Population-based risk factor management reduces CV risk in diabetes patients
medwireNews: A drive to improve cardiovascular (CV) risk factors at the level of the healthcare system results in reduced vascular risk in patients with diabetes, research shows.
The initiative occurred within Kaiser Permanente Northern California (KPNC) during 2004–2013, following the previous success of a similar program to improve blood pressure control at the population level.
According to data from the US National Healthcare Effectiveness Data and Information Set, the prevalence of poor glycemic control (glycated hemoglobin [HbA1c]>9.0%) at a national level worsened during this period, from 31% to 34%. But it improved within KPNC, from 28% to 18%.
The number of diabetes patients within KPNC over this time period varied between around 98,000 and 122,000. The patients were not Medicare recipients and therefore relatively young, with only 0.9–8.6% of patients being older than 65 years during a given study year.
Clinicians within KPNC were provided with an evidence-based algorithm for CV risk factor control, via means including email, pocket cards, lectures, and electronic medical record decision support tools. They were encouraged to use the algorithm whenever clinically appropriate. The project also involved nurse and pharmacist care managers, who proactively identified and contacted diabetes patients whose risk factors could be managed with the algorithm.
In addition to improved glycemic control, the diabetes patients within KPNC achieved a greater improvement in the rate of lipid control (low-density lipoprotein cholesterol <100 mg/dL), which rose from 47% to 71%, compared with a nonsignificant improvement from 40% to 44% at the national level.
The blood pressure control rate within KPNC was markedly higher than the national average at baseline, at 77% versus 57%, because of the previous program addressing this risk factor. It improved further, to 82% during the expanded CV risk factor program, but this increase was not significantly larger than that at the national level, where the rate improved to 62%.
“Our study provides a real-world example of the successful implementation of a population management program to control cardiovascular risk factors in people with diabetes, associated with substantial improvement in risk factor control after implementation of the program,” write Jamal Rana (Kaiser Permanente Northern California, Oakland, USA) and co-researchers in The American Journal of Medicine.
They suggest their program “may be an effective and potentially scalable model transportable to other health care delivery systems.”
medwireNews is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group
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